Call the Midwife is back for a seventh season and so are the faculty of the Vanderbilt University School of Nursing with a weekly guest blog. Watch the show Sundays at 7 p.m. through May 6, then read our blog each Monday morning for historical and contemporary context about the previous night’s episode. SPOILER ALERT: Some posts may contain spoilers.

I have very distinct memories of being in fourth grade, about 10 years old, and being shepherded into a dark classroom with all the other girls in my grade to watch a movie entitled Growing Up and Liking It. Embarrassed giggles masked our curiosity as the teachers displayed samples of feminine hygiene products, much like the scene in this week’s episode of Call the Midwife. It may be hard to believe that teaching basic human biology could evoke controversy, but the debate about how reproduction and sexual health should be taught continues even today. With the average age of menarche, the first period, being about 12 years old, mothers may find themselves having uncomfortable conversations about puberty earlier than they expected.

Fortunately, women have more choices in products for period management than ever before. Disposable and reusable menstrual cups, cloth pads and panty liners, menstrual sponges, and special absorbent underwear are newcomers to the scene once dominated by sanitary napkins held in place with girdle-like belts and rubber sanitary aprons. Intrauterine devices, extended cycling birth control pills and other hormonal birth control options provide some women with a desired benefit of fewer, lighter or even no periods.

Menstruation has recently stirred up political controversy. Taxes on feminine products continues in most states, although some states now include pads and tampons as tax-exempt necessities. Critics of the “tampon tax” hold that women are being discriminated against simply for their biology given that menstruation is not a choice and must be contained somehow. In 2016, when New York decided to make feminine hygiene products tax-free, it was estimated that the state’s revenue would decrease by $10 million annually.

Access to products is another issue. Advocates for incarcerated women, for example, have voiced concerns about restrictions on the number of pads women were allocated monthly and the total number of pads women were allowed to have in their possession. While incarcerated women are able to purchase additional supplies, women would need to work more than 20 hours to buy a 20-count box of tampons under current prison wages. Federal prisons changed their policy in 2017 as public awareness of the issue grew, and women gained free access to unlimited pads and tampons. The majority of incarcerated women are held in state facilities, however, and many of those institutions still have restrictions on menstrual supplies.

While discussing menstruation and female biology may have us sympathizing with Nurse Lucille, who was visibly uncomfortable during the presentations, Nurse Valerie’s advice to look young women straight in the eye and answer their questions is sound. For many people, talking about periods in public is taboo, but it is important for women of all ages to have trusted people to turn to for answers about their gynecologic and sexual health. Midwives can help fill that role.

Bethany Domzal Sanders, MSN, CNM, is a member of the Vanderbilt Nurse-Midwives, the clinical practice of the Vanderbilt University School of Nursing located at West End Women’s Health Center.